How Can I help new 90 year old

[dianeQ]

This forum has been a great help to me, so I'm hoping you can give some answers. I have been a cpap user for 10 years. My 90 year old father finally agreed to a sleep study -- "severe sleep apnea", apnea/hypopnea 98 per hour, Delta and REM sleep 0%. He's a zombie.

He has been given a Resmed S9 Escape, Humidaire 5i, Resmed Swift Fx. Pressure 11, ramp at 5. They also gave him a chin strap because he sleeps with his mouth open some of the time. He's a side and back sleeper. (I have a S9 auto, so I can alter any settings if necessary.)

When I arrived from out of town for the holidays he had been refusing to use the equipment and it took several days to convince him it was worth it. (I explained that he was like a prisoner tortured with sleep depravation, and that finally seemed to make an impression!)

FINALLY got him to try the last few nights. The mask seems to be a good fit, and there is no leaking. The problem is that he seems to be fighting it, couldn't stop focusing on it and couldn't get to sleep. It's lasts only 15 minutes and he gives up, but to get him to even try for 15 minutes is a MAJOR victory and I need to build on that. We didn't try the chin strap -- I thought that was too much to begin with.

So, does anyone have any suggestions for how I can help him? What can I SAY to ease him into this? The man falls asleep in the middle of dinner! so it shouldn't be a problem, but he wouldn't stop fighting and just relaxe and breathe with the mask. CPAP is so easy for me that I don't know how to explain. He's so generally befuddled (half asleep all the time) that it's hard to get through to him, but at least he's listening now. I have to leave in 5 days, so I'm a bit desperate.

He's a stubborn old guy, and that's a large part of the problem, but unbelievably healthy for his age except for the apnea, so this should make a huge improvement in his life if we could just get him going.

Any suggestions will be very welcome.

Diane

[BlackSpinner]

Maybe get him to try on other masks. Watch tv together both wearing your equipment to get used to it?

[xenablue]

Diane, I'm a newbie at this, but because I hate anything near my face, let alone strapped firmly to it, it took me a while to get used to the mask.

What I did (and still do over 2-mths later) is sit up in bed, put my mask on, and either watch TV or read for a while. During that time I fiddle with the fine tuning of making the mask both comfortable and reasonably leak-proof.

Doing this helps A LOT with getting used to the feel of the mask. Once it's been on for a few minutes and I'm busy reading or watching TV, I forget to focus on breathing and I'm pretty much falling asleep before I turn the TV off.

I hope your dad gets the hang of the CPAP - you know he'll feel much better.

Cheers,
xena

[STL Mark]

I'm no doctor, but I have stayed at a Holiday Inn Express. My father is a similar age and a bit stubborn. If I was working with him, I would turn ramp off, set pressure at 7, and set EPR at 3. And let him try it while he watches TV or something so he is a bit distracted. He may seem to find it more comfortable once he gets used to the process. Then creep the pressure back up to 11 as he becomes compliant.

[dianeQ]

Thanks, TV sounds like a good idea -- he falls asleep watching it all the time.

Diane

[dianeQ]

If I was working with him, I would turn ramp off, set pressure at 7, and set EPR at 3.

Could you explain why?

Thanks, Diane

[LoQ]

What can I SAY to ease him into this?

He's cognitively impaired; untreated sleep apnea can make it very difficult to think rationally.

I think you are going to have to look for creative ideas. Make a game out of it while he is awake or going to sleep. "Can you take 10 really deep, slow breaths with the mask on? Let's see how many you can do." Offer a reward. Try some aroma therapy via the intake; this does not have to be expensive--some people just put a little dish with some vanilla near the intake. Ask his physician for a hypnotic for a few nights so that he will stop fighting and go to sleep.

See if you can get him to take a nap with the machine on. Tell him he doesn't have to go to sleep, just lie down with the mask and machine on. If he goes asleep by any chance, he may discover that it makes him feel better. Part of the problem with night time sleep is that we are all geared to "I need to get sufficient sleep," and that may be why he is fighting it. If you try it at a time when he doesn't HAVE to sleep, he may accept it better.

You can try explaining to him that the feeling of "this is not normal" will not last forever. Have you told him not to fight it, just go with it? 11 cm may be too high to start with. I second the recommendation to change it to 7 cm until he gets used to it. If that works, move the pressure up a notch or two every couple of nights. Or set the ramp to be 45 minutes and start the ramp at 4 or 5 cm.

You may have to hire a knowledgeable caretaker to put him to bed every night until he has bought in to the program. I recommend DoriC.

[jazzer4]

Your earning your wings helping your Dad. Good for you.

I would do all sugguested above.

I would also walk around in my mask and tell him DAD IF I CAN DO IT YOU SURE CAN AS YOUR MY DAD.

It will be hard, as he is suffering now in many ways from his Sleep Apnea. I will be hard for him to understand most of what you want him to do....BUT PLEASE KEEP TRYING. And, let use know how it's going.

Susan

[sleepycarol]

It must be hard, knowing that you will be leaving in a few days and then your dad will be on his own trying to cope with the machine and using it faithfully.

Has he observed the difference it has made in your life? If you live far away and only get home a few times of year, he may not recognize the impact it has made in your life.

Does Benadryl make him drowsy -- that is over the counter and would save a trip to the doctor if he is able to take it. Ask the DME to work with you finding a mask that he finds the most tolerable. Most of us have had to go through several masks before finding the one that suits us the best.

Does anyone that you trust nearby to help your dad after you are gone?

[cwied]

Does Benadryl make him drowsy -- that is over the counter and would save a trip to the doctor if he is able to take it.

Just a quick comment: I have a friend who is a geriatrician who warns against giving Benadryl to the elderly. It is known to make some older people "crazy" (as in completely losing touch with reality). Please be very careful and consult a physician before giving Benadryl to anybody over 70.

[KatieW]

Benadryl is not recommended if using cpap, as it can cause central apneas.

[dianeQ]

Thanks for all the great advice -- I'll give it a try tonight and report back.

The full time caregiver is my mother -- 86 years old -- they won't tolerate anyone else in the house while they still feel they can cope (which they can for many things). She's not entirely with it, but better than he is. My sisters help when needed during the day, but while I'm staying here I can help at bedtime.

Diane

[DoriC]

What can I SAY to ease him into this?

He's cognitively impaired; untreated sleep apnea can make it very difficult to think rationally.

See if you can get him to take a nap with the machine on. Tell him he doesn't have to go to sleep, just lie down with the mask and machine on. If he goes asleep by any chance, he may discover that it makes him feel better. You may have to hire a knowledgeable caretaker to put him to bed every night until he has bought in to the program. I recommend DoriC.

Yes, One good nap is what worked here. Bedtime caused too much anxiety the first few days. The first time he fell asleep in his recliner for an hour nap and woke so refreshed he was then willing to try it at bedtime. And the Dr did give him some Ambien 5mg which he used on/off for about 3 months. You're a good daughter! I hope your sisters are knowledgeable?

[Lizistired]

How did he feel after his titration. I noticed the difference the next day. I couldn't wait to get mine. Maybe the ordeal was such a hassle he didn't notice.
I think the nap is a good idea. I am only on week 2 and take my mask off for awhile most nights. I have started listening to my body. If I'm tired, I put my mask on and take a nap.
My 75 y/o dad is doing an oximetry test at home tonight so I may be going through the same thing very soon.

[sleepycarol]

I was just trying to think of alternatives that might work -- she is on a timeline and some doctors won't just call in a script and with the holidays it can be hard to get in to a doctor or at least in this part of the country on short notice.

I think most sleep aides have serious side effects including prescription ones. If one could get by without them it would probably be best.

I hope that you get your dad on track before you leave!! I only hope that I can make it to 90!!